53c Mainwood Road, Timperley, Cheshire, WA15 7JW

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End of Life Care Patient Charter

The Maples & Lakes Medical Centre

End of Life Care Patient Charter

A charter for the care of people who are nearing the end of their life

“You matter because you are you; you matter to the last moment of your life and we will do all we can, not only to let you die peacefully, but to help you live until you die.” Dame Cicely Saunders

We want to offer people who are nearing the end of their life the highest quality of care and support. We wish to help you live as well as you can, for as long as you can. Therefore, if and when you want us to, we will:

  • Listen to your wishes about the remainder of your life, including your final days and hours, answer as best we can any questions that you have and provide you with the information that you feel you need;
  • Help you think ahead so as to identify the choices that you may face, assist you to record your decisions and do our best to ensure that your wishes are fulfilled, wherever possible, by all those who offer you care and support;
  •  Talk with you and the people who are important to you about your future needs. We will do this as often as you feel the need, so that you can all understand and prepare for everything that is likely to happen;
  • Endeavour to ensure clear written communication of your needs and wishes to those who offer you care and support both within and outside of our surgery hours;
  • Do our utmost to ensure that your remaining days and nights are as comfortable as possible, and that you receive all the particular specialist care and emotional and spiritual support that you need;
  • Do all we can to help you preserve your independence, dignity and sense of personal control throughout the course of your illness;
  • Support the people who are important to you, both as you approach the end of your life and during their bereavement.

We also invite your ideas and suggestions as to how we can improve the care and support that we deliver to you, the people who are important to you and others in similar situations.

For more information from the Practice End of Life Care Lead, please contact:

Dr I Fichardt

0161 498 8484 or SMCCG.MaplesMedical@nhs.net

Advance Care Plan/Advanced Directive

(Planning my Future Care)

As individuals we may wish to put-in-place a record of what is important to us so that if we experience ill-health or an unforeseen event, like an accident, and become unable to make decisions we can be reassured by knowing we have already made clear our preferences.

This will help your family, carers, friends and professionals to discuss your future care with you.

None of us can identify exactly how our life will progress and how our end of life will look. Designing this plan gives you the opportunity to start these conversations, make your decisions or at least make your preferences known and clearly noted.

We have designed a draft plan that we hope you will find useful. Please feel free to amend it to suit your requirements. You may like to add photos to your plan.

This plan is not a legal document, but should you chose to use it please keep it safe so people can refer to it should the need arise.

You may find it useful (if you haven’t already done so) to have a file of important papers. While you may know exactly where to put your hands on them, your family may have the distress of searching through drawers when they need to find important papers quickly.

There are several documents that people, even in excellent health may wish to consider, to ensure they are discussed, actions taken and then left until such a time as they are needed. We hope this plan will act as a top sheet for your important information file.

We have included details suggested by carers who have had the experience of a death in the family and struggled to locate important information.

If you are worried about your memory you might find it useful to complete “this is me” a leaflet that gives greater detail about your likes and dislikes, in case you need to go to somewhere unfamiliar such as hospital.

If you need help with any of these documents then speak to your health or social care advisor or contact the Citizens Advice Bureau or Age UK who may be able to help.

Please keep this document in a safe place with other relevant documents. Remember to review it on a regular basis.

Tell the people you trust where they can find it.

My Personal Details
My first name:



My religion / spiritual faith is:





Maiden name:



My GP details are:


I prefer to be called:



Date of birth:



My solicitor’s details are:


Place of birth:



National Insurance number:



My NHS number:



Executor details:


My husband / wife / partner is called:



I live with:



My home address:








Job title and employer:


My phone number:



Accountant details:


My mobile number:



My e-mail address:




Who and What is Important to Me?
People who are important to me:













Places or things that are important to me

(e.g. this could be your home, items of furniture or even places you have been on holiday and really enjoyed):






















Pets who are important to me:


The way I live my life that is important to me.(e.g. this could be that you like to have everything tidy and in its own place, or personal – e.g. spiritual / religious preferences, or particular ideas for your hair / clothing):





















My Future Care Preferences
Most people prefer to live in their own home for as long as possible, however it may be that you become too sick or unable to care for yourself. Do you have preferences you would like people to consider in this regard? (e.g. this could be a particular residential home or area you would like to live in): What I don’t want to happen or prefer not

to happen (e.g. I would prefer not to die in

hospital, but in my own home):






















Family / carer comments – things they would like to record either that have been discussed and agreed or that you still are considering:





















Is There Anything Else You Would Like Anyone Reading This To Know?



















My Important Papers
Please record if you have the following documents: Yes No
Organ Donor Card
End of Life Preferred Priorities of Care (available through end-of-life healthcare professionals)
Advance Decisions to Refuse Treatment (see www.adrtnhs.co.uk for more information)
Do not attempt Cardio Pulmonary Resuscitation Form
Lasting Power of Attorney – 2 types:

1) Property and Financial Affairs

2) Health and Welfare

Both are legal documents. They don’t specifically have to be drawn up by a solicitor, but LPAs must be registered with the Office of the Public Guardian (see https://www.gov.uk/government/collections/lasting-power-of-attorney-forms)

Funeral Plans
Please try to keep these documents all together,

so that it’s easy for anyone trying to track things down for you.

Tell people you trust where they can find these documents.



Family Members / Informal Carers
Name Relationship to me Phone number Do they hold a copy of your plan? (Y / N) Next of Kin (Y / N)


Any Professionals Involved

(e.g. Social Care Practitioner / Nurse)

Name Role Organisation Phone number Do they hold a copy of your plan? (Y / N)


Signed By
Your name:
Witnessed by:

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